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YP-CDN KE Membership Registration form MARCH 2017
This is a membership registration form for Young Professionals Chronic Disease Network Kenya. A registration fee of 200Ksh will be levied to become a member. This amount is only payable by MPESA to the number 0707636514 upon completion of the form. You will receive a confirmatory receipt via email within 3 working days.
Date of Birth
Which town are you based in?
Which is your field of focus/expertise?
Art & Design
What are your main areas of interest? Check only 3 areas.
Road Traffic Injury
Access to Medicines
What are some of your additional skills that you can help YP-CDN Ke with?
Tick all that apply
IT and Design
Which YP-CDN Ke programmatic areas do you want to volunteer with?
Rheumatic heart disease clubs
Access to medicines
In what capacity do you want to volunteer for YP-CDN Ke?
Describe any area you will be comfortable working in.
How much time can you volunteer for the period from Jan-Jun 2017? (Kindly be as detailed as possible)
once a month
If you have volunteered before, please give details of where you have volunteered, for how long and describe your volunteer role.
Why do you want to Join YPCDN?
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